The treatment of acute diarrhea in children. An historical and physiological perspective.

This review examines the historical, physiological, clinical, and epidemiological evidence to support a method of therapy for children's diarrhea that may be recommended for general acceptance. The understanding and use of fluid and nutritional therapy of acute diarrhea in childhood have progressed over the years to a point where acute mortality can be reduced to nearly zero. At the same time, the ill effects on electrolyte balance and nutrition may be reduced to a minimum. Through use of an oral glucose electrolyte solution with a carefully designed composition, physiologically correct treatment may now be so simplified and inexpensive as to be readily available to the remote, under-served areas of the world where most of the morbidity exists; and be useful as well to more sophisticated settings. The method of therapy recommended in this paper has several important departures from traditional teaching. It advocates rapid restoration of extracellular fluid with a polyelectrolyte solution containing sodium, base and potassium; use of an oral glucose electrolyte solution for repletion of those not in shock and for maintenance; use of a single oral glucose electrolyte solution for all age groups, regardless of diagnosis, and quite early feeding with tolerated foods. Sodium loads given are generally higher than advocated by standard pediatric teaching. The origins of that teaching and support for the newer approach come from a detailed analysis of current knowledge in the epidemiological, clinical, and physiological aspects of diarrheal illness.